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A deciding role

Why ES need to get more involved in design decisions

ES professionals must play a role in surface specification and other design issues. Photo by simonkr/Thinkstock

A month doesn't go by when a hospital or health system is not announcing a new construction project and the folks charged with maintaining these facilities are quoted as saying they weren't involved in the design and construction process.

What is missing from these scenarios are proactive, sustainable measures being implemented by environmental services (ES) professionals to mitigate budgetary deficiencies and additions to facility maintenance.

According to the U.S. Army's Military Construction program, construction projects of 750,000 square feet and larger take an average of four years from start to occupancy, including six to 12 months of planning, four to six months of design, and 12 to 18 months of construction. Moreover, it is estimated that 50 percent of all U.S. construction projects run 200 percent over budget in both dollars and time. The average cost of pre-project planning is 2.4 percent of the total. Thus, less than 3 percent of the total construction budget goes into preplanning.

As documented by the volume of reports and articles regarding these construction projects, it is incumbent upon ES professionals and the keepers of the environment to get more involved in the design and surface specifications process.

An ES professional is already preparing to fail if he or she says "they are breaking ground for a new facility, construction is slated to begin in a month and we will take it over in about 18 months" or "we were not involved in the design and construction of a project and we found many problems when it was turned over to us."

Starting with flooring

ES professionals need to assert themselves as subject matter experts and the knowledgeable keepers of the environment. They need to become experts on surface types, standards, product-life expectancies and, most importantly, how the buildings will be maintained and at what cost.

One place to start is by looking at life expectancies of flooring surfaces. The chart on Page 45 uses data from the International Association of Certified Home Inspectors (IACHI). Although it is for residential and not commercial products, it still can translate to commercial use for illustration purposes.

The highlighted flooring types are commonly used in health care construction. Even a quick glance shows that health care facilities select and install products with the shortest life expectancy. Then, they are amazed that they cannot support them years after installation.

If one postulates that the life expectancy of any flooring material is 75 percent of the manufacturer's estimated product life, health care facilities are installing materials that will fail in a minimum of six years in the case of carpet, and a maximum of 20 years in the case of hard flooring.

Assuming that daily maintenance of a hard-surface corridor (whether it is vinyl composition tile or stone materials) is similar and, therefore, provides no significant savings over time from one hard flooring type to another, one can then look at maintenance costs over the 20-year life expectancy for hard-surface flooring.

For this example, it will be assumed that annual maintenance of hard surface corridors includes both scrubbing and refinishing (SCR) and stripping and finish (STF). SCR includes dry mopping with a 24-inch mop, applying and agitating the scrubbing solution, picking up the solution with a wet vacuum, rinsing with a large mop and applying two coats of finish. STF includes dry mopping with a 24-inch mop, prepping the baseboards, applying and agitating the stripping solution, picking up the stripping solution with a wet vacuum, rinsing with a large mop and applying two coats of finish.

Utilizing the International Sanitary Supply Association (ISSA) time standards for each task, the time requirements for SCR would be approximately 2.36 hours per 1,000 square feet per project; and the time requirements for STF would be approximately 3.46 hours per 1,000 square feet per project.

Given 3.46 hours to strip and finish 1,000 square feet and an additional hour of dry time, an ES team is looking at approximately 5 hours for 1,000 square feet of flooring from start to finish.

When the number of times this function will be conducted in a facility has been calculated and the appropriate total square footage of hard-surface flooring to be stripped and finished has been determined, ES professionals have a significant labor requirement for a hard flooring surface that is aging quickly and will, in less than 20 years, need to be replaced.

Aging facilities

According to the Almanac of Hospital Financial & Operating Indicators: A Comprehensive Benchmark of the Nation's Hospitals, 2011 edition, which was published by Ingenix Inc., the "average age of plant" is a financial metric that indicates how old a hospital's fixed assets are. It is based on the assumption that hospitals use a straight-line depreciation methodology.

The median value for this metric has held steady at about 10 years from 2005 to 2009, the most recent year for which data were available. Ingenix expects that the median will increase over the next five years. There are regional differences — hospitals in the Northeast had a median of about 11 years in 2009, while those on the West Coast were close to nine years.

There appears to be an understanding that certain fixed assets have a life expectancy and hospitals must appropriate monies for future repair and replacement. However, flooring dollars are not spent the same because they are for aesthetics as well as functionality.

Few care if a chiller tower is attractive to the eye. It is more important that it provide the required functionality. The facility budgets for the appropriate equipment based on performance needs, and it budgets for it to be offline, repaired and replaced. Yet, ES departments are hard-pressed to get the appropriate time to clean an area, let alone take it offline.

According to the Commercial Building Inventory (CBI), which bills itself as the nation's most detailed database of information about commercial buildings in the United States, commercial buildings had an average age of 50 years as of mid-2011. On average, the year built was 1961. These conclusions are based on a sampling of 4.42 million buildings for which the year built was available in local tax assessor records. They were slightly more than half of all commercial buildings by street address.

As demonstrated in the chart at left, which was created using data from the IACHI and the World Floor Covering Association, the high- and low-cost options of various flooring materials can vary greatly over 40 years. And that's not including the cost of maintaining the flooring surfaces.

Nationally, hospitals are 43 years old on average. Yet, hospitals continue to fit their facilities with surfaces designed to last six to 20 years, with proper maintenance schedules.

Worker fatigue

Finally, as health care facilities age and become harder to maintain, their ES staffs also are aging.

According to data produced by the Department of Labor's Bureau of Labor Statistics in 2012, median employee tenure varied by age. Older workers tend to have more years of tenure than their younger counterparts.

For example, the median tenure for employees 65 and older was 10.3 years in January 2012, more than three times the tenure for workers age 25 to 34 (3.2 years). More than half of all workers age 55 and older worked for at least 10 years for their current employers in January 2012, compared with 13 percent of workers age 30 to 34.

Moreover, Census Bureau data show that 33 percent of the workforce will be 50 or older by 2016; and 19 percent of the workforce will be 65 or older by 2050. ES staffs are not only aging faster than at any time in history, they are not leaving their positions for retirement or different positions. This creates fewer openings for upward movement in the department and reduces potential productivity.

Having fewer and older workers being called upon to maintain more floor area potentially can lead to lower productivity levels. This makes the decision to choose the correct flooring material and the need for the ES department to be a part of the selection process crucial.

Future success

The future success of an ES department depends on its involvement in every phase of building planning, design and maintenance.

All ES professionals can think of examples such as "the building was turned over to us and that is when we found out there were no janitors' closets"; "the three-story atrium was handed over without providing ES staff with any means to reach lights to change the light bulbs or clean the fixtures"; and "the built-in trash containers were too small, so we had to buy larger ones to place in front of them."

Hopefully, ES departments can use this information to gain inclusion into the design and construction process.

Bob Paine, CHESP, is director of operations at Acuity Concepts Inc., Foxboro, Mass. He can be reached atbob@bobpaine.com.

The opinions expressed by authors do not necessarily reflect the policy of the American Hospital Association. This website contains links to sites which are not owned or maintained by the American Hospital Association(AHA). The AHA is not responsible for the content of non-AHA linked sites, and the views expressed on non-AHA sites do not necessarily reflect the views of the American Hospital Association.